Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009

Size: px
Start display at page:

Download "Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009"

Transcription

1 The Healthcare Imperative: Lowering Costs and Improving Outcomes Patient Engagement Issues Nancy Davenport-Ennis President & CEO National Patient Advocate Foundation September 8 th, 2009 Institute of Medicine Washington, DC

2 What is Patient Engagement? Patient Engagement is defined as actions that individuals must take to prevent disease and obtain the greatest benefit from knowledge of both disease prevention and the health care services available to them in though today s U.S. health care. * The values of Engagement Behavior Frameworks are to help patients, caregivers, individuals, to seek out and make use of services, technologies, and drugs to interact with health professionals and institutions if they are to benefit from healthcare. *Gruman, PhD, 2009

3 Pivotal Co-Factors in Managing Healthcare These are fundamental questions that must be answered as each answer is a pivotal co-factor in managing healthcare decisions. What is it costing the patient? Where is the savings going: to the health care consumer, the health care provider, or insurer? Where is the savings potential? Remedies must be clinically advantageous and cost effective for patients. Will the savings be recognized through taking advantage of alternative treatments or medicines for patients? Will patients be recommended for available alternative therapies to cut costs? Are patient out-of-pocket expenses expected to be reduced? What are the concerns involving bundled services that may not be ordered by treating physicians if the providers will not break event when they are reimbursed by the insurance company? What is the understanding for patients if they are purchasing drug (bundles)? What happens if they do not get used? A universal question. Since bundling is at its infancy in the United States, will bundling afford patients the ability to access the newest therapeutic protocols inclusive of imaging, surgery, pharmaceutical/ biotechnology services, rehabilitation service required and specific maintenance protocols?

4 A Step Forward What s the Difference Between DRGs & Bundled Services? Emerging episode-based payment models have some relationship to existing payment systems that bundle services around a clinical condition or service event. For example, Diagnosis Related Groups (DRG) bundle inpatient hospital services during a hospital stay for the purposes of prospective payment. The Medicare hospital outpatient prospective payment system also bundles many services provided during outpatient visits. However, these systems focus on care provided in single settings, while emerging g models of episode-based payments (bundled payments) attempt to capture the full range of services delivered in all or most settings during a clinical episode. - Episode-Based Payment Summary, Mathematic Inc.

5 History of DRGs Diagnosis-related group (DRG) is a system to classify hospital cases into one of approximately 500 groups and were developed for Medicare as part of the prospective payment system. DRGs have been used since 1983 to determine how much Medicare pays hospitals for treating a certain diagnosis. Instead of reimbursing hospitals separately for each service provided, hospitals are paid predetermined, set rates based on the patient s diagnosis under DRG. DRGs are a precursor of bundled payments accelerating the concept of aggregate service billing for multiple services provided at one site of service to one bundle of billing for multiple services across multiple sites of care with one single point of payment The risk to patients and the payor community is in how we define the components to be billed within the bundle.

6 Why Bundling? In its June 2008 report to Congress, MedPAC found that 18% of Medicare hospital admissions result in readmissions within 30 days post-discharge; accounting for $15 billion in spending in According to MedPAC, approximately $12 billion may represent potentially preventable readmissions. i MedPAC recommended exploring the use of a bundled payment system for an episode of care where separate payments for distinct types of providers would be eliminated. Bundling ggoes beyond DRGs because it bundles payment for all acute care provided in hospitals as well as post-acute care provided in both acute care hospitals and nonhospital settings. Bundled payment system may be easier to implement for some conditions than for others (example: easier for a CABG or a hip replacement than for a chronic disease such as diabetes). Conditions with clearly defined treatment protocols with clear start and end dates may be more feasible for a bundled payment system. Bundling may provide an opportunity to reduce costs and encourage compliance by physicians using published treatment guidelines.

7 Implementation of ProvenCareSM In 2006, Geisinger i Health System in Pennsylvania implemented ProvenCareSM which bundled payment for all non-emergency CABG procedures. The bundle included: d the preoperative evaluation, all hospital and professional fees, all routine post-discharge care, and management of any complications occurring within 90 days of the procedure (Paulus, Davis, and Steele, 2008). Geisinger adopted a patient compact that was designed to engage patients as participants in ensuring favorable outcomes through compliance to treatment protocols. Hospital costs dropped by 5 percent and 30 day readmission rates fell from 15.5 percent to 7 percent.

8 Deere s Experience with New Consumer-Directed Plan Bundling is an insurance process of reimbursement that holds promise of financial advantage to consumers. Requires extensive education Learning to become wiser consumers and more engaged in their healthcare Cultural Change and making the change understandable by translating their insurance benefits into improved health status Supports next generation consumerism Requires proactive consumer engagement and leads to sustained positive behavior

9 Deere s Experience with New Consumer- Directed Plan (continued) Deere & Company, based in Moline, IL, replaced its existing health options with a consumer-direct plan in January 2007, after an extensive 18-month period of explaining to employees that reasons for the change and details of the new plan. So far, the company is pleased with the outcome. Spending their own money, they (workers) became much wiser consumers and much more engaged in their health care, said Olson, Deere s manager of health and welfare plans. We saw that t focusing on the health status t of our employees was really important to us, and our own medical trends as a whole moderated. One of the keys to the success to far, Olson said, was making the change understandable. At the same time, the company sought a cultural change that encouraged workers to become more involved in determining their health care insurance needs and translating their insurance benefits into improved health status. -Ebri.org notes, March 2009, Volume 30, # 3

10 National Education Campaign There has been a paradigm shift from do what your doctor says to study and analyze quality & cost information and make decisions. Need to educate patients to the value proposition and explain risk and benefits of all services. How to Educate and With Whom? Non-profit groups Insurers Physicians Web Direct mail Site of Service

11 How to Interpret and Explanation of Benefits (EOB) Medical bills need to be simplified. The more consumer s understand medical costs and quality, the better decisions they make

12 Bundling Responsibility First Do No Harm -As translated from the Hippocratic Oath

What Providers Need To Know Before Adopting Bundling Payments

What Providers Need To Know Before Adopting Bundling Payments What Providers Need To Know Before Adopting Bundling Payments Dan Mirakhor Master of Health Administration University of Southern California Dan Mirakhor is a Master of Health Administration student at

More information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How Health Reform Will Affect Health Care Quality and the Delivery of Services Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care

More information

Use and Value of Data Analytics. Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF)

Use and Value of Data Analytics. Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF) Use and Value of Data Analytics Comparative Effectiveness Study Inpatient Rehab Hospital (IRH) vs. Skilled Nursing Facility (SNF) Ryan Wilson Vice President of Managed Care HealthSouth Corporation Gerry

More information

Empowering Value-Based Healthcare

Empowering Value-Based Healthcare Empowering Value-Based Healthcare Episode Connect, Remedy s proprietary suite of software applications, is a powerful platform for managing value based payment programs. Delivered via the web or mobile

More information

1900 K St. NW Washington, DC 20006 c/o McKenna Long

1900 K St. NW Washington, DC 20006 c/o McKenna Long 1900 K St. NW Washington, DC 20006 c/o McKenna Long Centers for Medicare & Medicaid Services U. S. Department of Health and Human Services Attention CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re:

More information

Bending the Health Care Cost Curve in New York State:

Bending the Health Care Cost Curve in New York State: Bending the Health Care Cost Curve in New York State: Implementation Plan to Adopt Bundled Payment Methods October 2010 Prepared by The Lewin Group Acknowledgements Kathy Kuhmerker and Jim Teisl of The

More information

Empowering Value-Based Healthcare

Empowering Value-Based Healthcare Empowering Value-Based Healthcare Episode Connect, Remedy s proprietary suite of software applications, is a powerful platform for managing value-based payment programs. Delivered via the web or mobile

More information

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques

Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health

More information

How to Incorporate Bundling into the Revenue Cycle

How to Incorporate Bundling into the Revenue Cycle How to Incorporate Bundling into the Revenue Cycle Len Kalm HCA VP Managed Care Shannon Dauchot Parallon Business Solutions SVP Corporate Operations Revenue Cycle 1 Headquarters based in Nashville, TN

More information

Medicare Payment System Design: An Overview

Medicare Payment System Design: An Overview Medicare Payment System Design: An Overview January 15, 2009 Mark E. Miller, Ph.D. Executive Director Medicare Payment Advisory Commission A. Bruce Steinwald Director, Health Care U.S. Government Accountability

More information

EFFECT OF THE HOME HEALTH PROSPECTIVE PAYMENT SYSTEM

EFFECT OF THE HOME HEALTH PROSPECTIVE PAYMENT SYSTEM Department of Health and Human Services OFFICE OF INSPECTOR GENERAL EFFECT OF THE HOME HEALTH PROSPECTIVE PAYMENT SYSTEM ON THE QUALITY OF HOME HEALTH CARE Daniel R. Levinson Inspector General January

More information

LUNG CANCER CLINICAL TRIALS

LUNG CANCER CLINICAL TRIALS UNDERSTANDING LUNG CANCER CLINICAL TRIALS 1-800-298-2436 LungCancerAlliance.org A GUIDE FOR THE PATIENT 1 TABLE OF CONTENTS INTRODUCTION TO CLINICAL TRIALS What Is a Clinical Trial?...4 Types of Clinical

More information

Accountability and Innovation in Care Delivery Models

Accountability and Innovation in Care Delivery Models Accountability and Innovation in Care Delivery Models Lisa McDonnel Senior Vice President, Network Strategy & Innovation, United Healthcare November 6, 2015 Today s discussion topics Vision Our strategic

More information

Moving Towards Bundled Payment

Moving Towards Bundled Payment ISSUE BRIEF Moving Towards Bundled Payment Introduction The fee-for-service system of payment for health care services is widely thought to be one of the major culprits in driving up U.S. health care costs.

More information

Regulatory Compliance Policy No. COMP-RCC 4.32 Title:

Regulatory Compliance Policy No. COMP-RCC 4.32 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.32 Page: 1 of 4 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2)

More information

2014: Volume 4, Number 1. A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics

2014: Volume 4, Number 1. A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics 2014: Volume 4, Number 1 A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics Medicare Post-Acute Care Episodes and Payment Bundling Melissa Morley,¹

More information

Healthcare Billing Guide:

Healthcare Billing Guide: Healthcare Guide Healthcare Billing Guide: Strategies to Master Insurance and Billing Published by www.dorlandhealth.com Tips on Understanding Your Medical Bill 1 Healthcare Billing Guide: Strategies to

More information

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM?

BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? Uniform Data System for Medical Rehabilitation Annual Conference August 10, 2012 Presented by: Donna Cameron Rich Bajner

More information

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed?

Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Benefit Design and ACOs: How Will Private Employers and Health Plans Proceed? Accountable Care Organizations: Implications for Consumers October 14, 2010 Washington, DC Sam Nussbaum, M.D. Executive Vice

More information

Value-Based Purchasing

Value-Based Purchasing Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based

More information

POPULATION HEALTH MANAGEMENT: VALUE- BASED PAYMENT MODELS: CARE REDESIGN IN TOTAL JOINT REPLACEMENT HCSRN Conference: April 2016

POPULATION HEALTH MANAGEMENT: VALUE- BASED PAYMENT MODELS: CARE REDESIGN IN TOTAL JOINT REPLACEMENT HCSRN Conference: April 2016 POPULATION HEALTH MANAGEMENT: VALUE- BASED PAYMENT MODELS: CARE REDESIGN IN TOTAL JOINT REPLACEMENT HCSRN Conference: April 2016 TAMARA CULL, NATIONAL DIRECTOR, POPULATION HEALTH ACCOUNT MANAGEMENT Tamara

More information

A Foundation for Health Care Reform Legislation

A Foundation for Health Care Reform Legislation A Foundation for Health Care Reform Legislation Mayo Clinic s Point of View Mayo Clinic believes that U.S. health care urgently needs reform to ensure access to quality, affordable patient care. Each major

More information

Law Department Policy No. L-6 Title:

Law Department Policy No. L-6 Title: I. SCOPE: Law Department Policy No. L-6 Page: 1 of 7 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity

More information

Reimbursement Driving HealthCare Value, May 2014 Dublin, Ireland

Reimbursement Driving HealthCare Value, May 2014 Dublin, Ireland Reimbursement Driving HealthCare Value, May 2014 Dublin, Ireland Professor Bob Kaplan May 2014 All health care systems around the globe face a fundamental problem. How should governments, insurance companies

More information

3M s unique solution for value-based health care

3M s unique solution for value-based health care A quick guide to 3M s unique solution for value-based health care Part 2: The era of and Current trends industry changes Volume-based health care Value-based health care ICD-9 ICD-10 Inpatient care Outpatient

More information

UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans

UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans General Clinical Guidelines for Payment Review Updated May 2015 Introduction The UnitedHealthcare Medicare Solutions

More information

Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use

Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use June 23, 2011 Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Table of

More information

Patient Billing. Questions/ Answers. Assistance Programs

Patient Billing. Questions/ Answers. Assistance Programs Patient Billing Questions/ Answers Assistance Programs Table of Contents Patient billing: an introduction... 1 Patient financial responsibilities... 2 Our promise to you... 3 Frequently asked questions...

More information

Regulatory Compliance Policy No. COMP-RCC 4.07 Title:

Regulatory Compliance Policy No. COMP-RCC 4.07 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest

More information

Preventing Readmissions

Preventing Readmissions Emerging Topics in Healthcare Reform Preventing Readmissions Janssen Pharmaceuticals, Inc. Preventing Readmissions The Patient Protection and Affordable Care Act (ACA) contains several provisions intended

More information

Chapter Seven Value-based Purchasing

Chapter Seven Value-based Purchasing Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It

More information

Using Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota

Using Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota Using Medicare Hospitalization Information and the MedPAR Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota MedPAR Medicare Provider Analysis and Review Includes information

More information

ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE

ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE Overview This guide includes an overview of Medicare reimbursement methodologies and potential coding options for the use of select remote

More information

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I

DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I DRIVING VALUE IN HEALTHCARE: PERSPECTIVES FROM TWO ACO EXECUTIVES, PART I A firm understanding of the key components and drivers of healthcare reform is increasingly important within the pharmaceutical,

More information

Healthcare Reform Update Conference Call VI

Healthcare Reform Update Conference Call VI Healthcare Reform Update Conference Call VI Sponsored by the Healthcare Reform Educational Task Force October 9, 2009 2:00-2:45 2:45 pm Eastern Healthcare Delivery System Reform Provisions in America s

More information

Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1. Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review

Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1. Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1 Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review Robin Persun Excelsior College COST-CONTROLLING MEASURES

More information

Improving Hospital Performance

Improving Hospital Performance Improving Hospital Performance Background AHA View Putting patients first ensuring their care is centered on the individual, rooted in best practices and utilizes the latest evidence-based medicine is

More information

WHAT IS MEDICAL MANAGEMENT? WHAT IS THE PURPOSE OF MEDICAL MANAGEMENT?

WHAT IS MEDICAL MANAGEMENT? WHAT IS THE PURPOSE OF MEDICAL MANAGEMENT? WHAT IS MEDICAL MANAGEMENT? How health plans make decisions to approve payment for medical treatment is a poorly understood part of the healthcare system. One part of the process, known as medical management,

More information

Alternatives to Fee-for-Service Payments in Health Care

Alternatives to Fee-for-Service Payments in Health Care AP PHOTO/M. SPENCER GREEN Alternatives to Fee-for-Service Payments in Health Care Moving from Volume to Value Maura Calsyn and Emily Oshima Lee September 2012 W W W.AMERICANPROGRESS.ORG Alternatives to

More information

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Date 2015-04-17 Title Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and

More information

Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education

Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education 1 Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education Centers Care for Elders Governing Council Acknowledge

More information

NOVOSTE BETA-CATH SYSTEM

NOVOSTE BETA-CATH SYSTEM HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve

More information

Reducing Readmissions with Predictive Analytics

Reducing Readmissions with Predictive Analytics Reducing Readmissions with Predictive Analytics Conway Regional Health System uses analytics and the LACE Index from Medisolv s RAPID business intelligence software to identify patients poised for early

More information

COM Compliance Policy No. 3

COM Compliance Policy No. 3 COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION

More information

ORTHOPAEDIC BUNDLED PAYMENT INITIATIVES:

ORTHOPAEDIC BUNDLED PAYMENT INITIATIVES: RELIANCE CONSULTING GROUP ORTHOPAEDIC BUNDLED PAYMENT INITIATIVES: RISKS & RETURNS Sponsored by: 8-28-12 TENNESSEE ORTHOPAEDIC SOCIETY Presenters: John P. Schmitt, Ph.D. - RCG Managing Director & Joane

More information

Primer: Skilled Home Health Care

Primer: Skilled Home Health Care Primer: Skilled Home Health Care Emily Egan July 9, 2012 Skilled home health care is a critical component of the healthcare system, in which providers care for homebound patients with acute, chronic and

More information

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs

More information

Alcohol and Chemical Dependency Treatment Programs

Alcohol and Chemical Dependency Treatment Programs Alcohol and Chemical Dependency Treatment Programs Marworth Overview Recognized as a national leader in alcohol and chemical dependency treatment, Marworth has developed highly specialized treatment programs

More information

Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge

Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge PREPARED FOR: ARA Research Institute PRESENTED BY: Al Dobson, Ph.D. PREPARED

More information

June 2, 2014. RE: File Code CMS-1608-P. Dear Ms. Tavenner:

June 2, 2014. RE: File Code CMS-1608-P. Dear Ms. Tavenner: . June 2, 2014 Marilyn Tavenner Centers for Medicare & Medicaid Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue SW Washington, DC RE: File Code CMS-1608-P Dear Ms. Tavenner: The

More information

The Changing Face of Medical Necessity under ICD-10

The Changing Face of Medical Necessity under ICD-10 The Changing Face of Medical Necessity under ICD-0 Sponsored by 95 N. Fine Ave #04 Fresno CA 93720-565 Phone: (559) 25-5038 Fax: (559) 25-5836 www.californiahia.org Program Handouts Monday, June 8, 205

More information

Responses to Questions on Protection of Medicare Beneficiaries

Responses to Questions on Protection of Medicare Beneficiaries www.alz.org Public Policy Office 202 393 7737 p 1212 New York Avenue, NW 866 865 0270 f Suite 800 Washington, DC 20005-6105 The Honorable Max Baucus Chairman Senate Finance Committee The Honorable Orrin

More information

Managing Population Health: Equity through Person- Centered Care

Managing Population Health: Equity through Person- Centered Care Managing Population Health: Equity through Person- Centered Care Linda Alexander, RN, MBA, CCM Total Health Care Chief Clinical Officer Plante Moran Healthcare Consulting Detroit Medical Center - Clinical

More information

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE:

STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: January 2011 STRATEGIC INNOVATIONS FOR AFFORDABLE, SUSTAINABLE HEALTH CARE: A Model for Health System Reform Environmental Scan Accountable Care Organizations Table of Contents ACCOUNTABLE CARE ORGANIZATIONS...

More information

THE EVOLUTION OF CMS PAYMENT MODELS

THE EVOLUTION OF CMS PAYMENT MODELS THE EVOLUTION OF CMS PAYMENT MODELS December 3, 2015 Dayton Benway, Principal AGENDA Legislative Background Payment Model Categories Life Cycle The Models LEGISLATIVE BACKGROUND Medicare Modernization

More information

A guide for the patient

A guide for the patient Understanding series LUNG CANCER CLINICAL TRIALS 1-800-298-2436 LungCancerAlliance.org A guide for the patient TABLE OF CONTENTS The Basics What is a Clinical Trial?...3 Types of Clinical Trials... 3 Phases

More information

Expanding Telemedicine Services in an Effort to Reduce Health Care Costs in the United States

Expanding Telemedicine Services in an Effort to Reduce Health Care Costs in the United States Expanding Telemedicine Services in an Effort to Reduce Health Care Costs in the United States To: Federal Trade Commission From: Jaime Coffino, MPH Candidate, Mailman School of Public Health, Columbia

More information

Transfer DRGs: Approaches to Revenue Recovery. A BESLER White Paper

Transfer DRGs: Approaches to Revenue Recovery. A BESLER White Paper Transfer DRGs: Approaches to Revenue Recovery A BESLER White Paper June 2014 Copyright 2014 BESLER Consulting. All rights reserved. *HFMA staff and volunteers determined that Transfer DRG Revenue Recovery

More information

THE ROLE OF LONG TERM ACUTE CARE HOSPITALS IN THE ACUTE CARE CONTINUUM. Wednesday, June 02, 2010

THE ROLE OF LONG TERM ACUTE CARE HOSPITALS IN THE ACUTE CARE CONTINUUM. Wednesday, June 02, 2010 THE ROLE OF LONG TERM ACUTE CARE HOSPITALS IN THE ACUTE CARE CONTINUUM Wednesday, June 02, 2010 As A Provider Of Continuing Nursing Education, Triumph Healthcare Is Required By Texas Nurses Association

More information

Defining the Boundaries Between NHS and Private Healthcare

Defining the Boundaries Between NHS and Private Healthcare Defining the Boundaries Between NHS and Private Healthcare Policy: COM 30 Document Version Control Version 0.1 Draft Pilot version 08/07/09 Version 1.0 Ratified 07/09/09 Version Version Version Version

More information

The Big Data Dividend

The Big Data Dividend The Big Data Dividend Enhancing Revenue in an Era of Change May 7, 2015 Agenda Big Data Sample Healthcare Big Data Sets Healthcare Applications of Big Data Revenue Enhancement Opportunities Rate Benchmarking/Rate

More information

Transitions of Care Management Coding (TCM Code) Tutorial. 1. Introduction Meaning of moderately and high complexity 2

Transitions of Care Management Coding (TCM Code) Tutorial. 1. Introduction Meaning of moderately and high complexity 2 Transitions of Care Management Coding (TCM Code) Tutorial Index 1. Introduction Meaning of moderately and high complexity 2 2. SETMA s Tools for using TCM Code 3 Alert that patient is eligible for TCM

More information

A different kind of health insurance.

A different kind of health insurance. A different kind of health insurance. For individuals, families, and small businesses. We were built for you. CHM_SMM01_1013 A different kind of partner for the new world of health insurance. The Affordable

More information

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians

Value-Based Programs. Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Value-Based Programs Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians Issue: U.S. healthcare spending exceeds $2.8 trillion annually. 1 With studies

More information

Reducing Hospital Readmissions & The Affordable Care Act

Reducing Hospital Readmissions & The Affordable Care Act Reducing Hospital Readmissions & The Affordable Care Act The Game Has Changed Drastically Reducing MSPB Measures Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE

More information

Executive Summary. Chronic Obstructive Pulmonary Disease (COPD) Acute Exacerbation Episode

Executive Summary. Chronic Obstructive Pulmonary Disease (COPD) Acute Exacerbation Episode Executive Summary Chronic Obstructive Pulmonary Disease (COPD) Acute Exacerbation Episode OVERVIEW OF A COPD ACUTE EXACERBATION EPISODE The chronic obstructive pulmonary disease (COPD) acute exacerbation

More information

Defining the boundaries between NHS and Private Healthcare

Defining the boundaries between NHS and Private Healthcare Commissioning Policy (EMSCGP005V2) Defining the boundaries between NHS and Private Healthcare 1. Definitions Private patients are patients who receive private healthcare, funded on a pay-asyou-go basis

More information

TRENDWATCH. Medicare, Medicaid and most states. Addendum: Background On Post-Acute Care. PAC Provider Snapshot and Overlap of Patient Characteristics

TRENDWATCH. Medicare, Medicaid and most states. Addendum: Background On Post-Acute Care. PAC Provider Snapshot and Overlap of Patient Characteristics AMERICAN HOSPITAL ASSOCIATION DECEMBER 2015 TRENDWATCH Addendum: Background On Post-Acute Care Medicare, Medicaid and most states recognize four types of post-acute care (PAC) settings: long-term acute-care

More information

Purposes of Patient Records

Purposes of Patient Records CHAPTER 6 Documentation 1 Slide 1 Purposes of Patient Records Five Basic Purposes for Written Records Written communication Permanent record for accountability Legal record of care Teaching Research and

More information

Accountable Care Organizations Understanding What They Are and How to Structure Them

Accountable Care Organizations Understanding What They Are and How to Structure Them Accountable Care Organizations Understanding What They Are and How to Structure Them Maria T. Currier HOLLAND & KNIGHT LLP Miami Chamber of Commerce Healthcare Subcommittee December 7, 2010 Copyright 2010

More information

Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA

Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA Rehabilitation Reimbursement Update By: Cherilyn G. Murer, JD, CRA Introduction The Centers for Medicare & Medicaid Services (CMS) and legislators in this country remain dedicated to ensuring that beneficiaries

More information

800 17th Street, NW Suite 1100, Washington, DC 20006

800 17th Street, NW Suite 1100, Washington, DC 20006 800 17th Street, NW Suite 1100, Washington, DC 20006 September 3, 2015 Mr. Andrew Slavitt Acting Administrator, Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H.

More information

Accountable Care Fundamentals for Medical Practice Executives

Accountable Care Fundamentals for Medical Practice Executives Accountable Care Fundamentals for Medical Practice Executives Nathan Anspach, FACMPE Senior Vice President and Chief Executive Officer John C. Lincoln Accountable Care Organization and John C. Lincoln

More information

Outpatient dialysis services

Outpatient dialysis services O n l i n e A p p e n d i x e s 6 Outpatient dialysis services 6-A O n l i n e A p p e n d i x Medicare spending by dialysis beneficiaries is substantial FIGURE 1-3 Figure 6 A1 Medicare population Dialysis

More information

Providing and Billing Medicare for Transitional Care Management

Providing and Billing Medicare for Transitional Care Management PYALeadership Briefing Providing and Billing Medicare for Transitional Care Management Updated November 2014 2014 Pershing Yoakley & Associates, PC (PYA). No portion of this white paper may be used or

More information

What is Home Care Case Management?

What is Home Care Case Management? What is Home Care Case Management? Printed in USA Arcadia Home Care & Staffing www.arcadiahomecare.com Case Management: What is it why is it important? While different approaches to healthcare today are

More information

FLORIDA WORKERS' COMPENSATION REIMBURSEMENT MANUAL FOR HOSPITALS 2004 EDITION. Rule 69L-7.501, Florida Administrative Code

FLORIDA WORKERS' COMPENSATION REIMBURSEMENT MANUAL FOR HOSPITALS 2004 EDITION. Rule 69L-7.501, Florida Administrative Code FLORIDA WORKERS' COMPENSATION REIMBURSEMENT MANUAL FOR HOSPITALS 2004 EDITION Rule 69L-7.501, Florida Administrative Code Effective January 1, 2004 1 TABLE OF CONTENTS Title Page Section 1: Managed Care

More information

Driving Value Through Clinical Integration

Driving Value Through Clinical Integration Driving Value Through Clinical Integration How Independent Physician Groups and Independent Practice Associations (IPAs) can remain independent and profitable in a changing healthcare reimbursement environment

More information

CMS Gainsharing Demonstration Projects. Mark Wynn, Director Division of Payment Policy Demonstrations, CMS

CMS Gainsharing Demonstration Projects. Mark Wynn, Director Division of Payment Policy Demonstrations, CMS CMS Gainsharing Demonstration Projects Mark Wynn, Director Division of Payment Policy Demonstrations, CMS Overview of Presentation Medicare demonstrations Gainsharing background Description of current

More information

Inpatient Transfers, Discharges and Readmissions July 19, 2012

Inpatient Transfers, Discharges and Readmissions July 19, 2012 Inpatient Transfers, Discharges and Readmissions July 19, 2012 Discharge Status Codes Two-digit code Identifies where the patient is at conclusion of encounter Visit Inpatient stay End of billing cycle

More information

Transitioning to Accountable Care

Transitioning to Accountable Care Transitioning to Accountable Care Harold D. Miller ABOUT THE AUTHOR Harold D. Miller is the Executive Director of the Center for Healthcare Quality and Payment Reform and the President and CEO of the Network

More information

Walden University Q & A continued from Webinar Todd Linden

Walden University Q & A continued from Webinar Todd Linden Walden University Q & A continued from Webinar Todd Linden General Note: The answers to these questions are my opinion. The mountain of rules and regulations that will be produced from this legislation

More information

Early Lessons learned from strong revenue cycle performers

Early Lessons learned from strong revenue cycle performers Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from

More information

Post-acute care providers: Shortcomings in Medicare s fee-for-service highlight the need for broad reforms

Post-acute care providers: Shortcomings in Medicare s fee-for-service highlight the need for broad reforms C h a p t e r7 Post-acute care providers: Shortcomings in Medicare s fee-for-service highlight the need for broad reforms C H A P T E R 7 Post-acute care providers: Shortcomings in Medicare s fee-for-service

More information

Perspective on Payer-Based Electronic Personal Health Records

Perspective on Payer-Based Electronic Personal Health Records Healthcare technology solutions. Perspective on Payer-Based Electronic Personal Health Records Jeffrey H. Margolis Chairman and CEO, The TriZetto Group Copyright 2005 The TriZetto Group, Inc. Personal

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012 Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors

More information

RE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND

RE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND Memorandum TO: FROM: Glenn Hendrix Doug M. Hance DATE: RE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND Medicare s post-acute transfer policy distinguishes between discharges

More information

University of Mississippi Medical Center. Access Management. Patient Access Specialists II

University of Mississippi Medical Center. Access Management. Patient Access Specialists II Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue

More information

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY

A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY A STRATIFIED APPROACH TO PATIENT SAFETY THROUGH HEALTH INFORMATION TECHNOLOGY Table of Contents I. Introduction... 2 II. Background... 2 III. Patient Safety... 3 IV. A Comprehensive Approach to Reducing

More information

Acute Medical Rehabilitation Surviving Health Care Reform

Acute Medical Rehabilitation Surviving Health Care Reform Acute Medical Rehabilitation Surviving Health Care Reform Kathleen C. Yosko, RN, MS, MBA President & CEO Marianjoy Rehabilitation & Clinics Wheaton, Illinois Marianjoy Rehabilitation and Clinics 2 1 Acute

More information

Post-Acute/Long- Term Care Planning for Accountable Care Organizations

Post-Acute/Long- Term Care Planning for Accountable Care Organizations White Paper Post-Acute/Long- Term Care Planning for Accountable Care Organizations SCORE A Model for Using Incremental Strategic Positioning as a Planning Tool for Participation in Future Healthcare Integrated

More information

Commercial Bundle Program for Total Joint Replacements

Commercial Bundle Program for Total Joint Replacements Commercial Bundle Program for Total Joint Replacements 2015 Pilot Henry Ford West Bloomfield Hospital Presentation to University of Michigan, Industrial and Operations Engineering Andrea McAuliffe March

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

Appeal A request that your health insurer or plan review a decision that denies a benefit or payment (either in whole or in part).

Appeal A request that your health insurer or plan review a decision that denies a benefit or payment (either in whole or in part). Glossary of Health Coverage and Medical Terms This glossary defines many commonly used terms, but isn t a full list. These glossary terms and definitions are intended to be educational and may be different

More information

May 7, 2012. Submitted Electronically

May 7, 2012. Submitted Electronically May 7, 2012 Submitted Electronically Secretary Kathleen Sebelius Department of Health and Human Services Office of the National Coordinator for Health Information Technology Attention: 2014 edition EHR

More information

Creating Strategic Alliances for Post-Acute Coordination of Care

Creating Strategic Alliances for Post-Acute Coordination of Care Creating Strategic Alliances for Post-Acute Coordination of Care Kathleen Yosko, PhD President/CEO Wheaton Franciscan Health Care Sole Illinois property Free-standing facility 101 IRF beds 27 SNF beds

More information

Developing Successful Hospital Partnerships

Developing Successful Hospital Partnerships Developing Successful Hospital Partnerships Michael Logan, MHA Director of Operations Services Publication Date: May 2013 2013 Sawgrass Partners, LLC DEVELOPING SUCCESSFUL HOSPITAL PARTNERSHIPS Those aging

More information

Public Reporting of Cost and Resource Use

Public Reporting of Cost and Resource Use Public Reporting of Cost and Resource Use Cindy Schlough Director of Strategic Partnerships Wisconsin Collaborative for Healthcare Quality cschlough@wchq.org; (608) 826-6839 Aligning Forces for Quality

More information

Readmissions as an Enterprise Priority. Presenters 4/17/2014

Readmissions as an Enterprise Priority. Presenters 4/17/2014 Readmissions as an Enterprise Priority April 24, 2014 Presenters Vincent A. Maniscalco, MPA, LNHA Administrator Middletown Park Rehabilitation and Health Care Center Vmaniscalco@parkmanorrehab.com Eileen

More information

Discharge or Episode of Care? CMS Redefines the Interrupted Stay Rule for LTACHS. Cherilyn G. Murer, J.D., C.R.A.

Discharge or Episode of Care? CMS Redefines the Interrupted Stay Rule for LTACHS. Cherilyn G. Murer, J.D., C.R.A. Introduction Discharge or Episode of Care? CMS Redefines the Interrupted Stay Rule for LTACHS By Cherilyn G. Murer, J.D., C.R.A. When CMS first implemented the prospective payment system for long term

More information